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Presence of spur cells as a highly predictive factor of mortality in patients with cirrhosis
Author(s) -
Alexopoulou Alexandra,
Vasilieva Larisa,
Kanellopoulou Theoni,
Pouriki Sophia,
Soultati Aspasia,
Dourakis Spyridon P
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12473
Subject(s) - medicine , spur , cirrhosis , risk factor , gastroenterology , anatomy
Background and Aim The presence of spur‐cell anemia ( SCA ) is due to lipid disturbances of the erythrocyte membrane and may develop in patients with advanced liver cirrhosis. The accurate predicting value of SC for survival has not been clarified. The aim of this study was to evaluate SCA as a prognostic indicator in patients with cirrhosis. Methods We prospectively evaluated clinical, laboratory parameters, and survival in patients with cirrhosis, with or without SCA , during the period 2008–2011. Patients who had at admission renal failure, other causes of hemolytic anemia, hepatocellular carcinoma, sepsis, and/or active bleeding, were excluded. One hundred sixteen patients with cirrhosis were included. The presence of SCA ( SC rate higher or equal to 5% [≥ 5%]) was diagnosed in 36 (31%) patients. Results Patients with SCA compared to those without had more advanced liver disease (higher Model for End‐Stage Liver Disease [ MELD ], P < 0.001), higher total bilirubin ( P < 0.001), and International Normalized Ratio ( P < 0.001). Patients with SCA had worse survival (log rank P < 0.001). Survival of patients with SCA at the first, second, and third month of follow‐up was 77%, 45%, and 33%, respectively. In multivariate C ox's regression analysis, the presence of SCA was an independent predictor of mortality (hazard ratio = 3.17 [95% CI 1.55–6.48]). Conclusions The presence of spur‐cell anemia is not uncommon in cirrhosis and seems to be strongly associated with mortality. SCA can be used in combination with MELD as an additional predictor of early mortality.